Laws Banning Cigarettes in Bars Leave Loopholes for Hookah

In many major cities smoking cigarettes is banned in bars, but chances are patrons could legally walk to a nearby café and breathe in some hookah smoke that many believe is just as bad, if not worse, than cigarette smoke.

A new study led by Dr. Brian Primack at the University of Pittsburgh School of Medicine found that 73 of the 100 largest U.S. cities ban cigarette smoke in bars. However, 69 of these cities have laws with loopholes that allow hookah bars to continue operating without restrictions. In this study, Pittsburgh was considered to be among the 27 that don't ban smoking at all, due the number of exceptions in its law.

"I think what we need to do is standardize these laws," Primack said. "We need to say, 'What is the spirit and purpose of this law? And are these establishments violating that?'"

Studies comparing the health effects of hookah and cigarettes are relatively new, and there is no definitive evidence regarding which habit is worse, Primack said. "We do know, however, that there are a lot of toxicant exposures that are associated with hookah tobacco smoking. For example, we know that somebody who sits and has a standard hookah tobacco smoking session, they inhale about 38 times the tar that someone would in one cigarette."

It's important to note, however, that people addicted to hookah may only smoke once a day, whereas people addicted to cigarettes smoke much more frequently.

Many smoking bans, though, were enacted to prevent nonsmokers from breathing in toxins found in second hand smoke. In this regard, said Primack, hookah is a serious offender. According to a recent study, Primack said, "people walking out of a hookah bar who were nonsmokers … their blood was three times more concentrated with carbon monoxide compared with nonsmokers coming out of regular bars."

And this is big trouble, Primack said, because hookah bars are becoming more popular and are increasingly used by people who aren't coming to smoke. "A lot of these hookah bars operate as cafes. A lot of people go to these places as a cool place to sit with your laptop and do your work, like you might at Starbucks," Primack said. About half also sell alcohol and are places of general nighttime socializing among college populations, he said.

In a previous nation-wide study, Primack found almost as many college students had tried hookah (30.5%) as had tried cigarettes (34%). "This is not a fad or a trend anymore," Primack said. "This is a really substantial public health issue."

There are a number of reasons why people tend to underestimate hookah's risks. A lot is in the presentation: "It is done with these very beautiful apparatus. A lot of times the environment is very stimulating. There is a sweet smell in the air, because of the flavorings that are used," Primack said.

Plus, there's been a lack of targeted public education. "We've invested a lot in education about cigarettes," Primack said. "A lot of young people are responding to the education they've seen, to the manipulation of the tobacco industry that has been exposed, but it's those same people who have not necessarily been educated in the same way that tobacco is tobacco."